Provider Demographics
NPI:1679869895
Name:SHELTON, KACIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KACIE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 BRIARPARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3792
Mailing Address - Country:US
Mailing Address - Phone:713-244-0100
Mailing Address - Fax:
Practice Address - Street 1:3131 BRIARPARK DR STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3792
Practice Address - Country:US
Practice Address - Phone:713-244-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry